Humphries J O
School of Medicine, University of South Carolina, Columbia 29208, USA.
Clin Cardiol. 1998 Oct;21(10):711-8. doi: 10.1002/clc.4960211004.
Primum non nocere. Atrial fibrillation (AF) occurs commonly following coronary artery bypass graft surgery, although new onset atrial fibrillation in this setting is usually transient. When AF reverts or is converted to sinus rhythm it is unlikely to recur, whether or not the patient takes preventive medication. As no benefit (and sometimes increased risk) associated with reduced mortality or morbidity in this setting has been reported for antiarrhythmic agents, standard treatment should consist of observation or control of ventricular response with an appropriate agent until AF relapses to sinus rhythm. If an antiarrhythmic agent, especially a class I agent, is used because of persistent or recurrent AF in the early postoperative period, heart rhythm should be monitored as long as the class I agent is administered and treatment initiated if an undersirable rhythm develops. Atrial fibrillation in other clinical settings in patients with structural heart disease presents a more difficult management problem. Class I agents are reported to be associated with an increased risk of death, despite an efficacious effect of maintaining sinus rhythm. Amiodarone is reported to be well tolerated with respect to the cardiovascular system, but unacceptable noncardiac effects are reported. A safe amiodarone-like agent is greatly needed. Atrial fibrillation in patients with no structural heart disease is not discussed in this presentation.
首要原则是不伤害。冠状动脉旁路移植术后常发生心房颤动（房颤），不过在此情况下新发房颤通常是短暂的。当房颤恢复或转为窦性心律时，无论患者是否服用预防性药物，其复发的可能性都不大。由于在这种情况下未报告抗心律失常药物在降低死亡率或发病率方面有任何益处（有时风险还会增加），标准治疗应包括观察或用适当药物控制心室率，直至房颤恢复为窦性心律。如果因术后早期房颤持续或复发而使用抗心律失常药物，尤其是Ⅰ类药物，在使用Ⅰ类药物期间应监测心律，一旦出现不良心律即开始治疗。结构性心脏病患者在其他临床情况下的房颤则带来更棘手的管理问题。据报道，Ⅰ类药物尽管有维持窦性心律的有效作用，但与死亡风险增加有关。据报道，胺碘酮在心血管系统方面耐受性良好，但也有不可接受的非心脏方面的副作用报道。非常需要一种安全的类似胺碘酮的药物。本报告未讨论无结构性心脏病患者的房颤情况。
